New Participant Form

Please read each question carefully and answer each one truthfully.

Name
Status
Driving experience
Do you own a car, is it yours or rented?
Available class times
Available days of the week
Where would you receive your instruction?
Personal reference 1
Phone number
Personal reference 2
Phone number
Do you have a driver's license?
Did you pass your final driving test?
Do you regularly use any type of drugs or medication?
Does he/she have any learning disabilities? (ASD, ADHD)
This form is for gathering basic participant information. Participants authorize LATINOS DRIVE CLUB to use their names, videos, and images for advertising purposes. Your information will NOT be used for any other purpose. Confidentiality is guaranteed. If you are selected as a participant, you will be notified through this form and will then be required to sign it. Your behavior as a participant is your sole responsibility. NO REFUNDS WILL BE ISSUED IF YOU DECIDE NOT TO CONTINUE YOUR PARTICIPATION. We do not issue any type of driver accreditation certificate after your participation. Your participation must be canceled 48 hours before the start date via cash ($), verifiable Zelle, or credit/debit card. If a participant has paid for one or more sessions and they are not held or terminated for reasons that are their sole responsibility, they will be charged 50% of the amount paid, and the difference will be refunded within 48 hours. The client may not take their course classes within a period of no more than 45 consecutive days. If classes cannot be taken within this period, a penalty of 10% of the class/course cost will be charged. Participation is prohibited under the influence of alcohol, prohibited substances, or medications that impair driving ability (antihistamines, sleeping pills, etc.). No companions are allowed during training. Remember that your primary objective is to learn to drive according to the laws of the State of Georgia. Do not share this form with others without express authorization. Classes may be postponed if weather conditions are unfavorable.
I hereby state that I requested driving lessons on my own initiative.
Para atender los DUI estamos procesando la certificación ante el DDS(Directions Drivers and Services )
Please re-enter your first and last name as confirmation.